Understanding barriers and facilitators to clinic attendance and medication adherence among adults with hypertensive urgency in Tanzania

Abstract

Hypertensive urgency is a major risk factor for cardiovascular events and premature deaths. Lack of medication adherence is associated with poor health outcomes among patients with hypertensive urgency in resource-limited settings. To inform the development of tailored interventions to improve health outcomes in this population, this study aimed at understanding facilitators and barriers to clinic attendance and medication adherence among Tanzanian adults with hypertensive urgency. We conducted in-depth interviews with 38 purposively selected participants from three groups: 1) patients with hypertension attending hypertension clinic, 2) patients with hypertension not attending hypertension clinic, and 3) clinic health workers. Interviews were conducted using a semi-structured guide which included open-ended questions with prompts to encourage detailed responses. In their narrative, patients and healthcare workers discussed 21 types of barriers/facilitators to clinic attendance and medication adherence: 12 common to both behaviors (traditional medicine, knowledge and awareness, stigma, social support, insurance, reminder cues, symptoms, self-efficacy, peer support, specialized care, social services, religious beliefs); 6 distinct to clinic attendance (transport, clinic location, appointment, patient-provider interaction, service fragmentation, quality of care); and 3 distinct to medication adherence (drug stock, side effects, medicine beliefs). The majority of identified barriers/facilitators overlap between clinic attendance and medication adherence. The identified barriers may be surmountable using tailored supportive intervention approaches, such as peer counselors, to help patients overcome social challenges of clinic attendance and medication adherence.

Barriers and facilitators to satisfaction with diabetes care: The perspectives of patients attending public diabetic clinics in Dar es Salaam, Tanzania

“…In this study, a semi-structured interview guide developed by authors based on reviewed literature [ 18 , 27 , 28 ], and modified to suit the specific objectives of the study was used to collect information from the study participants. The guide was employed to gather in-depth information about the perceived barriers and facilitators toward satisfaction with diabetes care.…”

“…Diabetes clinics with a high patient satisfaction score, for example, have been reported to have high credibility in comparison with clinics having a low patient satisfaction score [ 15 , 16 ]. According to the findings in different parts of the world, patients who are satisfied with the health services offered are more likely to utilize health services in the future and comply with the treatment protocols [ 15 , 17 , 18 ].…”

Factors associated with medication adherence and therapeutic barriers: relationship with social support in the elderly / Fatores associados a adesão e barreiras a terapêutica medicamentosa: relação com o apoio social em idosos

“…However, research into medication adherence is a way of tracking strategies for dealing effectively with chronic health conditions, since the consequences of non-adherence on the ability to take medication can include sub-optimal responses, disease recurrence, adverse events, increased use of health services, unplanned hospitalizations, increased morbidity and mortality, and increased health care costs. [4][5][6][7][8][9][10] The ability to consume medication and adherence are influenced by factors related to consumers, their therapies, their medical conditions, social factors, healthcare providers and factors related to the healthcare system, and can therefore be interrelated, since non-adherence can result from a patient being unable to follow instructions or the difficulty of removing medication from the packaging, these are factors, among others, that can be identified as barriers to adherence to treatment, thus, the inappropriate use of medication has stimulated research to verify the factors related to barriers. In addition, many adverse health outcomes may be avoidable if appropriate measures are taken to identify these risk factors and optimize the ability to adhere to and use drugs.…”

Medication adherence and blood pressure control: A preliminary assessment of the role of health insurance in Nigeria and Ghana

“… 15 Other studies in Nigeria, Ghana and Tanzania also highlighted the role of poverty in patients’ adherence to medications and blood pressure control. 16 – 18 Patients might then typically resort to alternative medicines, self-prescriptions or outright stoppage of the medications. 8 , 9 , 14 …”

“…15 Other studies in Nigeria, Ghana and Tanzania also highlighted the role of poverty in patients' adherence to medications and blood pressure control. [16][17][18] Patients might then typically resort to alternative medicines, self-prescriptions or outright stoppage of the medications. 8,9,14 NHIA, therefore, to a large extent should provide acceptable cover and reduce the problem of poor BP control from poor medication adherence due to the direct cost of drugs.…”